Provider Demographics
NPI:1912332552
Name:MARSHALL, MELISSA DIANNE (MS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANNE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11825 RIDGE PKWY APT 1624
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-6521
Mailing Address - Country:US
Mailing Address - Phone:505-795-1042
Mailing Address - Fax:
Practice Address - Street 1:3305 W 144TH AVE UNIT 200
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-9483
Practice Address - Country:US
Practice Address - Phone:303-284-6569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5413235Z00000X
COSLP.003415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist